Dr. Bisanga - Implications of Miniaturisation and Longevity of Hair Transplant Results

[Raphael84]

Implications of Miniaturisation and Longevity of Hair Transplant Results

 

 

[Britanium]

Another nice “bite size” clip. Nicely done Dr Bisanga 🤩very interesting info. 

[ciaus]

 

Very interesting, so if I'm understanding correctly from the video, Dr Bisanga considers patients with 20% or more of the donor area having miniaturization/thinning not good candidates for HT.

What role does finasteride play in Dr Bisanga's evaluation in scenarios like these:

 

1-If a patient is at say 30% thinning in the donor and they get on finasteride and respond well, comes back in a year (or few years, 5 yrs etc) and the detectable thinning drops to %10, etc. --and the patient is willing to stay on the finasteride forever -would Dr Bisanga re-classify them as a good candidate, or consider them borderline and agree to the procedure but only on the condition that they accept the probability of at least some loss down the road,.....or would he still consider them a bad candidate and not agree to operate on them?

 

2-And then what about the people that have already been on finasteride, maybe minoxidil too, for years, making it more difficult to accurately evaluate the scope of vulnerable areas. -During consultation if he learns that someone has been on these meds for years, does he bring up this topic and try to get some pictures, honest evaluations from the candidate on how much worse their hair was before the meds -and has he ever disqualified someone based on that? 

[Raphael84]

Hi @ciaus

Thanks for the further questions.

1. If the individual was deemed a non candidate purely due to the higher levels of miniaturisation in his donor area, but upon treatment with finasteride and oral minoxidil (for example) after a period of time, miniaturisation levels had declined to an acceptable level, then the patient may be accepted for surgery. Depending on the unique case, Dr. Bisanga may recommend to continue on medication and revisit again to ensure that miniaturisation is maintained at a lower level, or if he has confidence that miniaturisation is now controlled (depending on the % of miniaturisation), he may be happy to proceed with surgery. This would be based on the understanding that the patient would commit to medication long term and this would be highlighted in any documents between the clinic and patient.
Again, this is considering that the only issue was miniaturisation and that all other factors such as donor density and hair groupings were favourable, and the individual was a good candidate apart from miniaturisation concerns.
If the individual was a "non or borderline" candidate due to extensive loss, average donor and average hair groupings. Considering the the additional concern of high levels of miniaturisation, then just because miniaturisation may now be controlled, due to other non favourable factors, surgery may not be recommended.

2. If a patient has been committed to medication for many years, depending on the case, even with photos pre treatment, it most cases it would not be possible to pin point exactly where each patient would now be in terms of extent of loss. All patients respond uniquely to medication and all patients extent and rate of loss may increase or decrease naturally. Dr. Bisanga will evaluate the patient at the time of consultation and if miniaturisation is not a concern at this time and the patient is a favourable candidate, then Dr. Bisanga would likely explain to continue with medication regimen to ensure that no "ground would be lost".

In all of these situations, as always, a patients age would also be an influential factor.

[cpfm]

1 hour ago, Raphael84 said:

Hi @ciaus

Thanks for the further questions.

1. If the individual was deemed a non candidate purely due to the higher levels of miniaturisation in his donor area, but upon treatment with finasteride and oral minoxidil (for example) after a period of time, miniaturisation levels had declined to an acceptable level, then the patient may be accepted for surgery. Depending on the unique case, Dr. Bisanga may recommend to continue on medication and revisit again to ensure that miniaturisation is maintained at a lower level, or if he has confidence that miniaturisation is now controlled (depending on the % of miniaturisation), he may be happy to proceed with surgery. This would be based on the understanding that the patient would commit to medication long term and this would be highlighted in any documents between the clinic and patient.
Again, this is considering that the only issue was miniaturisation and that all other factors such as donor density and hair groupings were favourable, and the individual was a good candidate apart from miniaturisation concerns.
If the individual was a "non or borderline" candidate due to extensive loss, average donor and average hair groupings. Considering the the additional concern of high levels of miniaturisation, then just because miniaturisation may now be controlled, due to other non favourable factors, surgery may not be recommended.

2. If a patient has been committed to medication for many years, depending on the case, even with photos pre treatment, it most cases it would not be possible to pin point exactly where each patient would now be in terms of extent of loss. All patients respond uniquely to medication and all patients extent and rate of loss may increase or decrease naturally. Dr. Bisanga will evaluate the patient at the time of consultation and if miniaturisation is not a concern at this time and the patient is a favourable candidate, then Dr. Bisanga would likely explain to continue with medication regimen to ensure that no "ground would be lost".

In all of these situations, as always, a patients age would also be an influential factor.

Thanks for the great write up Raphael! I have a question (might be off topic) - does Dr. Bisanga advices patients to combine finasteride with dutasteride pre op or after op?

I thank you in advance.

Edited November 16, 2020 by cpfm

[Raphael84]

@cpfmThanks for your support and your further question.

The recommendation of hair loss preventative medication is an appropriate approach for most males who are suffering from male pattern baldness. Obviously some individuals have their own preferences in terms of what they may be willing to consider or not, and some guys understandably prefer topical medication as opposed to oral. 

In terms of medication pre or post surgery, the earlier that a patient can begin a medication regimen, the earlier any improvement (stabilisation/strengthening) due to the medication can take effect. Oral medications can generally be continued as normal throughout the surgery process ad there is no need to discontinue before surgery and wait a period of time post surgery, as there is with topical medication that would be applied directly to the scalp. 

Dr. Bisanga often speaks about levels of miniaturisation in the donor area. The term "safe donor area" can be misleading. The donor area can still be susceptible to miniaturisation, which can compromise growth, yield and longevity of transplanted hair. In more extreme cases, it may result in an individual being deemed a non acceptable candidate. This is another reason why beginning mediation pre surgery makes sense. Medication can help to stabilise the donor area for patients with higher levels of miniaturisation. Whilst mentioning the "safe donor area", it is also important to appreciate that what is deemed as safe at 25, may look very different to what would be deemed safe in the same patient at 35 or 45, with miniaturisation and further loss. This is something that younger patients really must understand.

Dutasteride is less commonly recommended. With a larger percentage of patients now that are not open to the idea of using finasteride, then dutasteride does not enter the conversation. In many cases in my experience, dutasteride is discussed after being raised by the patient. For those patients who are interested in beginning dutasreride, Dr. Bisanga will often recommend introducing it on the weekend for example. Using finasteride as normal Monday - Friday, and then considering dutasteride Saturday and Sunday.

Dutasteride is also now available as a topical gel/cream solution such as finasteride, which calms the concerns for some patients.

Currently Dr. Bisanga is a proponent of low dosage oral minoxidil. Our patients have reported very favourable response to a daily dosage of 5mg.

[TorontoMan]

1 hour ago, Raphael84 said:

@cpfmThanks for your support and your further question.

The recommendation of hair loss preventative medication is an appropriate approach for most males who are suffering from male pattern baldness. Obviously some individuals have their own preferences in terms of what they may be willing to consider or not, and some guys understandably prefer topical medication as opposed to oral. 

In terms of medication pre or post surgery, the earlier that a patient can begin a medication regimen, the earlier any improvement (stabilisation/strengthening) due to the medication can take effect. Oral medications can generally be continued as normal throughout the surgery process ad there is no need to discontinue before surgery and wait a period of time post surgery, as there is with topical medication that would be applied directly to the scalp. 

Dr. Bisanga often speaks about levels of miniaturisation in the donor area. The term "safe donor area" can be misleading. The donor area can still be susceptible to miniaturisation, which can compromise growth, yield and longevity of transplanted hair. In more extreme cases, it may result in an individual being deemed a non acceptable candidate. This is another reason why beginning mediation pre surgery makes sense. Medication can help to stabilise the donor area for patients with higher levels of miniaturisation. Whilst mentioning the "safe donor area", it is also important to appreciate that what is deemed as safe at 25, may look very different to what would be deemed safe in the same patient at 35 or 45, with miniaturisation and further loss. This is something that younger patients really must understand.

Dutasteride is less commonly recommended. With a larger percentage of patients now that are not open to the idea of using finasteride, then dutasteride does not enter the conversation. In many cases in my experience, dutasteride is discussed after being raised by the patient. For those patients who are interested in beginning dutasreride, Dr. Bisanga will often recommend introducing it on the weekend for example. Using finasteride as normal Monday - Friday, and then considering dutasteride Saturday and Sunday.

Dutasteride is also now available as a topical gel/cream solution such as finasteride, which calms the concerns for some patients.

Currently Dr. Bisanga is a proponent of low dosage oral minoxidil. Our patients have reported very favourable response to a daily dosage of 5mg.

Thanks for the write up. Would oral minoxidil be able to supplement and replace topical application if it’s tolerable? 
 

and where is topical dut available?

[ciaus]

12 minutes ago, TorontoMan said:

Thanks for the write up. Would oral minoxidil be able to supplement and replace topical application if it’s tolerable? 

I take oral minoxidil due to skin conditions that prevent me from using the topical. The oral version is more potent and a replacement for the topical, don't use both formulations.

[cpfm]

On 11/18/2020 at 8:32 PM, Raphael84 said:

@cpfmThanks for your support and your further question.

The recommendation of hair loss preventative medication is an appropriate approach for most males who are suffering from male pattern baldness. Obviously some individuals have their own preferences in terms of what they may be willing to consider or not, and some guys understandably prefer topical medication as opposed to oral. 

In terms of medication pre or post surgery, the earlier that a patient can begin a medication regimen, the earlier any improvement (stabilisation/strengthening) due to the medication can take effect. Oral medications can generally be continued as normal throughout the surgery process ad there is no need to discontinue before surgery and wait a period of time post surgery, as there is with topical medication that would be applied directly to the scalp. 

Dr. Bisanga often speaks about levels of miniaturisation in the donor area. The term "safe donor area" can be misleading. The donor area can still be susceptible to miniaturisation, which can compromise growth, yield and longevity of transplanted hair. In more extreme cases, it may result in an individual being deemed a non acceptable candidate. This is another reason why beginning mediation pre surgery makes sense. Medication can help to stabilise the donor area for patients with higher levels of miniaturisation. Whilst mentioning the "safe donor area", it is also important to appreciate that what is deemed as safe at 25, may look very different to what would be deemed safe in the same patient at 35 or 45, with miniaturisation and further loss. This is something that younger patients really must understand.

Dutasteride is less commonly recommended. With a larger percentage of patients now that are not open to the idea of using finasteride, then dutasteride does not enter the conversation. In many cases in my experience, dutasteride is discussed after being raised by the patient. For those patients who are interested in beginning dutasreride, Dr. Bisanga will often recommend introducing it on the weekend for example. Using finasteride as normal Monday - Friday, and then considering dutasteride Saturday and Sunday.

Dutasteride is also now available as a topical gel/cream solution such as finasteride, which calms the concerns for some patients.

Currently Dr. Bisanga is a proponent of low dosage oral minoxidil. Our patients have reported very favourable response to a daily dosage of 5mg.

Thank you for the detailed reply.